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GPs warned over flaws in COPD diagnosis

GPs are exposing patients with COPD to ‘potential harm' by misdiagnosing COPD and overprescribing inhaled corticosteroids, a new study suggests.

Primary care researchers found that using the predicted and fixed thresholds for FEV1 and FVC, as recommended in guidance issued by both NICE and the Global initiative for Obstructive Lung Disease (GOLD) meant more than a quarter of COPD patients were treated inappropriately.

NICE guidance on COPD, published in June last year, states GPs must confirm a diagnosis of COPD with post-bronchodilator spirometry, and brought the NICE grading of COPD, into patients with mild, moderate, severe and very severe disease into line with the GOLD classification system.

Researchers from King's College London identified 4,791 COPD patients in registers from 65 practices in south London.

Their data showed complete spirometry was recorded in only two-thirds of patients, of whom 962, or 30%, did not meet GOLD diagnostic criteria for COPD.

They also found of the remaining 2,203 in whom spirometry was incompletely recorded, 62% of the patients were inappropriately treated across all four GOLD stages.

The most common source of deviation from the guidelines was over-prescription of inhaled corticosteroids in patients with mild or moderate COPD and patients with severe to very severe COPD with no history of severe exacerbations.

The researchers warned the over-treatment with inhaled corticosteroids risked side-effects including an increased risk of pneumonia.

Lead researcher Hannah Thornton, a researcher assistant in primary care and public health at King's College London, concluded: ‘Diagnosis was made without spirometric confirmation for the majority of COPD patients on practice registers.

‘The deviation from guidelines in prescribing is substantial. There is potential for harm due to over-prescription of inhaled corticosteroids.'

The research was presented at the London and south-east regional meeting of the Society for Academic Primary Care earlier this month.